Transformation and Technology

Transcription

1 All Together Now : Communities that Care Transformation and Technology Dr. Kevin Doughty Parc Y Scarlets, Llanelli Thursday, 30 th. March, 2017 The Four Eras of Care 1 st Institutional focus (1 st Era) Geriatric hospitals replacing the Workhouse and Public Assistance Institutions 1

2 The Four Eras of Care Community focus (2 nd Era) Sheltered housing, residential care homes, home helps and domiciliary care in the home, and personal assistants 1 st 2 nd The Four Eras of Care Person focussed (3 rd Era) Use of technology to support health, well-being and independence, and to avoid the need for long-term care 1 st 2 nd 3 rd This is a transition and requires a business, service and cultural transformation ALWAYS difficult to achieve 2

3 The Four Eras of Care Cybercare (4 th. Era) Use of intelligent systems and data to support self-care and DIY health and social care to improve Quality of Life and well-being 1 st 2 nd 3 rd This requires DIGITAL TRANSFORMATION What is Digital Transformation? 3

4 Assistive Technologies Quick/cheap to provide Fixed AT (Home adaptations) Portable AT (Tools for Living) mainly electronic Electronic AT (Sensory & functional support) mainly mechanical Connected AT (Remote support) Expensive or slow to provide Fixed Home The focus is on the property make it fit for the person Many installations funded by LAs through Disabled Facility Grants Av. cost to buy & install Av. cost to remove Big role for Home Improvement organisations 4

5 Technology Enabled Home Fixed AT (Home adaptations) Portable AT (Tools for Living) Electronic AT (Sensory & functional support) Connected AT (Remote support) Tools 4 Living & Equipment Stores 5

6 Technology Enabled Home Fixed AT (Home adaptations) Portable AT (Tools for Living) Electronic AT (Sensory & functional support) Connected AT (Remote support) Sensory & Functional A.T. Activity support Prosthetics 6

7 Sensory & Functional A.T. Activity support Prosthetics Speech deficits Environmental controllers Mobility devices Sensory aids esight A Vision Amplifier This is effectively an electronic seeing aid which amplifies the levels of light which fall on the eyes. It works particularly well in cases where visual acuity has been reduced through age, and is suited to use at night. User can control contrast, zoom and colour display. 7

8 Sensory & Functional A.T. Activity support Prosthetics Speech deficits Environmental controllers Mobility devices Sensory aids Muscle control and amplification Wearable Solutions to a Lack of Mobility The Honda Assist system straps on over the hips and legs, giving a mechanical boost to frail people who have reduced muscle strength. It can help someone to get upstairs without relying on a stairlift 8

9 Mind-controlled Prosthetic Allows Movement of Individual Fingers The fingers of a prosthetic limb could be controlled by thought with 76% accuracy. This could be boosted to 88% by grouping the ring and pinkie fingers together The TEC@Home Journey Community alarm systems 1 st 2 nd. 3 rd. 4 th. 5 th. 6 th. 7 th. INCREASING UNCERTAINTY

10 Community Alarm Systems Sometimes known as a button & a box approach Too timid Unaware 5% of a problem 12% Not wanting to disturb operator 17% Unworn pendant 38% Active devices - press or pull in emergency Denial 28% Community alarm systems The TEC@Home Journey Telecare alarm services 1 st 2 nd. 3 rd. 4 th. 5 th. 6 th. 7 th. INCREASING UNCERTAINTY

11 How alarm-based telecare works Example: Fall detection Individual s home Telecare hub / Dispersed Alarm Unit Help! Alarm Call handler call raised follows protocol 1. and 3. Sensor Call arranges handler automatically appropriate talks to raises service alarm response user to to dispersed work out what unit help is needed Telecare Monitoring Centre (TMC) Ouch! service user id, alarm type & location info Response Telecare alarm services Community alarm systems ANALOGUE TECHNOLOGY 1 st The TEC@Home Journey to Transformation 2 nd. Vital signs & activity monitoring 3 rd. DIGITAL TECHNOLOGIES 4 th. 5 th. 6 th. 7 th. INCREASING UNCERTAINTY

12 Telemonitoring of Vital Signs Activity Monitoring Systems Systems such as Just Checking and Canary can be installed in minutes to enable room and door activities to be recorded and viewed remotely over the Internet. Other systems such as Lively, Sense and 3 Rings use smaller sensors that can detect specific actions enabling alerts to be generated if routine tasks are not performed on time. 12

13 Community alarm systems The Journey Telecare alarm services Vital signs & activity monitoring Mobile devices, apps & wearable alarms 1 st 2 nd. 3 rd. 4 th. 5 th. 6 th. 7 th. INCREASING UNCERTAINTY GPS Devices to Find People Latest GPS devices also provide: Fall detection alerts People who carry a phone Geofence breach alerts People who wear a watch High speed travel alerts Lack of movement alerts They can be used by: People who carry a key ring or bag (or in pocket) Children, lone workers, people at risk of getting lost & care staff 13

14 GPS in Practice Create safe and unsafe zones known Track as Family GPS geofences tracker where or responders issues people alert know have when where been outside to look GPS Belt Other GPS Wearables Available in black and brown real leather Available in waist sizes 28 to 46 inches Can be switched on / off remotely Wireless conductive charging on a mat GPS Sneakers Available in black or white Available in sizes 4 to 10 Pity granny doesn t go running! 14

15 Smartphones We will all have one! Features Sensors, actuators and connectivity Powerful processors Microphone Large touch-screen colour display High quality audio Large memory and storage capacity Accelerometers Telephone and text-messaging GPS and GSM location Versatile apps Magnetometer In-App notifications and messaging Temperature Familiar interface options Camera(s) Lightweight and always available Vibration unit Battery life improving Bluetooth and Wi-Fi for connectivity Contactless and touch ID NFC and proximity sensor Ideal platform for mcare and mhealth applications Vulnerable people can now go out and feel protected! Health and well-being apps 15

16 The Journey Community alarm systems Telecare alarm services Vital signs & activity monitoring Mobile devices, apps & wearable alarms Home video services 1 st 2 nd. 3 rd. 4 th. 5 th. 6 th. 7 th. INCREASING UNCERTAINTY The 5 th Video-based Services Systems can overcome social isolation by linking people with their families many miles away TV set-top boxes or tablet devices for people living alone or in care homes Teleconference technology can help avoid visits to A&E, to GP surgeries and to specialist consultations Teleconferencing allows scheduled and on-demand services to improve efficiency and reduce the need to travel for staff and patients Providing security and access to properties New teleconcierge services will provide allow monitoring centres to provide remote access and to screen potential bogus callers Offering enhanced welfare checks, lifestyle advice and service reviews Identifying changing support needs at an early stage 16

17 Home & Virtual Therapy Services Gaming platforms such as Microsoft Xbox & Kinect, Nintendo Wii and Playstation They open up opportunities for people who need physiotherapy, occupational or speech & language therapy to perform exercises and participate in observed competitions in their own homes Community alarm systems The Journey Telecare alarm services Vital signs & activity monitoring Mobile devices, apps & wearable alarms Home video services Personal care technologies and the IoT 1 st 2 nd. 3 rd. 4 th. 5 th. 6 th. 7 th. INCREASING UNCERTAINTY

18 Collecting Health & Well-being Data Virtual Reality Immersion Virtual reality headsets can offer people an entertainment or reminiscence experience that can overcome the limitations of their mobility and finance. 18

19 Smart Homes and the Internet of Things Community alarm systems The Journey Telecare alarm services Vital signs & activity monitoring Personal care technologies Mobile devices, apps & wearable alarms and the IoT Home video services Social robotics, digital assistants, and artificial intelligence 1 st 2 nd. 3 rd. 4 th. 5 th. 6 th. 7 th. INCREASING UNCERTAINTY

20 Robotic Devices - From Companions to Butlers! Personal Assistants & Chatbots Name Siri Google Now Cortana Alexa M Bixby Company Apple Google Microsoft Amazon Facebook Samsung Communication Voice Voice & typing Voice Voice Typing Voice Capability Answer question, place calls Getting directions, reminders Manage calendar, PC file finding Streams music, cooking help Supports complex actions Able to use context 20

21 Personal Assistants & Chatbots Name Siri Google Now Cortana Alexa M Bixby Company Apple Google Microsoft Amazon Facebook Samsung Communication Voice Voice & typing Voice Voice Typing Voice Capability Answer question, place calls Getting directions, reminders Manage calendar, PC file finding Streams music, cooking help Supports complex actions Able to use context Amelia works for Enfield Council, answering telephone questions. She can answers many calls at the same time so no capacity issues. HOUSING Many smaller service providers (and some big ones!) Where Are We on the Transformation Journey? Only a handful of forward-thinking services 1 st 2 nd. 3 rd. 4 th. 5 th. 6 th. 7 th. INCREASING UNCERTAINTY

22 WISER Homes All properties for Smart assistive technologies can older or disabled transform homes and make people in South West them WISER: Wales could become Watchful monitoring activities WISER Homes & well-being of individual A big IoT application? Intelligent (and Informed) able to recognise problems & take action Safe (and Secure) able to prevent accidents and crime Empowering support individual to participate in events & tasks Responsive quick to react sympathetically to changing circumstances. WISER Homes Personalised menu suggestion based on activity levels and bio data Cooking suggestions and recipes from celebrity chefs online using ingredients in the smart fridge All food is automatically ordered by the smart fridge, using local sources Smart Kitchen Technology all interconnected 22

23 WISER Homes Prompts on medication Remote urine analysis Monitoring of pallor and skin blemishes Display of vital signs and hydration advice for the weather Messages for the day Smart Bathroom Technology all interconnected HOUSING Where Are We on the Journey? Many smaller Only a handful of service providers SOCIAL CARE forward-thinking (and some big ones!) services 1 st 2 nd. 3 rd. 4 th. 5 th. 6 th. 7 th. INCREASING UNCERTAINTY

24 Maslow s Hierarchy of Needs 5 SELF-ACTUALISATION 4 SELF-ESTEEM 3 BELONGING 2 SAFETY 1 PHYSICAL Hierarchy of TEC@Home Needs 5 SELF-FULFILLMENT 4 ESTEEM/INDEPENDENCE 3 SOCIAL CAPITAL/NETWORKS 2 SAFETY 1 PHYSICAL/ PHYSIOLOGICAL + 24

25 Hierarchy of Needs 1 PHYSICAL/PHYSIOLOGICAL Smart thermostats Curtain/Window controls Medication reminders Automated lighting Heart-rate/ECG Respiratory rate Body temperature Blood glucose Door entry Body weight Hydration Nutrition + These are all available and possible today using assistive technology and wearable devices but are not routinely available in Wales Hierarchy of TEC@Home Needs 2 SAFETY Pendant alarms Intruder monitoring Video doorbells Bed sensors Fall detectors Flood detectors Gas detectors Door/Property Exit Reminder alarms GPS localisation Timers Prompting aids + These are options that should be routinely available (with lots of choices) through telecare services 25

26 Hierarchy of Needs 3 SOCIAL CAPITAL/NETWORKS Telephone (fixed or mobile) Specialist phones 24 hour call centre Videophone/Skype Messaging apps/services Photo sharing Internet Social networks Robotic assistants Virtual events and services + Basic comms technology is available but not routinely used in Welsh telecare service delivery Hierarchy of TEC@Home Needs 4 ESTEEM/INDEPENDENCE Activity planners & schedulers Internet shopping apps Electronic banking Public transport timetables Meal planners Prompts/reminders Location alerts GPS backtrackers Alexa queries + These are electronic tools (or apps) that we all use routinely in our daily lives but are slow to be integrated into telecare services 26

27 Hierarchy of Needs 5 SELF-FULFILLMENT Simple radio/music finder and player Video reminiscence tools and services New augmented and virtual reality techniques/applications Virtual volunteering and meetings Learning and using new languages using Skype + Challenge for researchers and services find new applications of TEC@Home technologies that can improve Quality of Life Hierarchy of TEC@Home Needs 5 SELF-FULFILLMENT 4 ESTEEM/INDEPENDENCE 3 SOCIAL CAPITAL/NETWORKS 2 SAFETY EVERYONE IS DIFFERENT! Assessment is key to success - Know the person - Know ALL the technology No single pathway suitable for social care 1 PHYSICAL/ PHYSIOLOGICAL + 27

28 HOUSING Where Are We on the Journey? Many smaller Only a handful of service providers SOCIAL CARE forward-thinking (and some big ones!) services HEALTHCARE 1 st 2 nd. 3 rd. 4 th. 5 th. 6 th. 7 th. INCREASING UNCERTAINTY The TEC@Home Cost Avoidance Clock Stressed family carers Need for mental health services Personal accidents such as falls Police/Fire services for emergencies Ambulance presentation to A&E Hospital readmission (for same cause) Short-term admission to a care home Long-term admission to a care home Long-term care services More use of primary care Delayed transfers of care Unnecessary hospital admission 28

29 HOUSING Where Are We on the Journey? Many smaller Only a handful of service providers SOCIAL CARE forward-thinking (and some big ones!) services DIY CARE Self Management the 3 rd and 4 th Eras of Care HEALTHCARE 1 st 2 nd. 3 rd. 4 th. 5 th. 6 th. 7 th. INCREASING UNCERTAINTY The DIY Care & Support Market Personal Budgets 29

30 Orbital Media and University of Essex are creating a digital platform with machine learning principles, so that it can be trained with user data. It will align its responses precisely to natural language queries. Responses will be delivered via a photo-realistic avatar. Digital Transformation Implications for the Health and Social Care Economies No Cars No Inventory Care@Home No Real Estate No Hospitals? 60 30

31 Independent Information The Vivo Guide from the Liverpool dallas project supports users to find their own solutions (and services) Vivo Pro helps health & social care staff to find tried and test products to advise patients to buy and use, sharing opinions of solutions It provides the basis of self-assessment using the principles of the New Welsh Care Act Breaking Down the Barriers to Digital Transformation of Care Services PEOPLE. They need to embrace the vision and have the necessary skills and knowledge to deliver a plan that will realise the benefits of digital transformation, as well as working collaboratively with (and not for) the NHS and others. PROCESSES New protocols and arrangements (such as reablement and intermediate care) to deal with emergency situations, and holistic ones to deal with long term situations, conditions, and disabilities. TECHNOLOGY Understanding and using both electronic data sharing and prediction opportunities, and the emergence of new assistive devices and connected (telecare) systems to support independence and well-being. VISION PEOPLE PROCESSES TECHNOLOGY VISION. This needs to be shared by Welsh Government, local authorities, the NHS in Wales, housing authorities and communities. They need to be made aware of the potential and the benefits, and must not be scared at the prospect of using more technology. 31

32 Finally - Where Do We Draw the Line? Japanese bathing system for older people RI-MAN robot is equipped with sensors that show a body's weight, position smell! Thank you for your attention For more information, or for copies of slides or other papers on which this presentation has been based, please contact me: dr.k.doughty@btinternet.com and join for free at: icuhtec.org 32